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Antidepressants can cause relapse: study

Patients who use antidepressants are more likely to suffer relapse, McMaster researcher finds.

By Theresa BoyleHealth Reporter

Wed., July 20, 2011

Patients who use antidepressants are more prone to relapsing than those who struggle through melancholy without drugs, according to a study from McMaster University.

In a study published in the journal, Frontiers of Psychology, lead author Paul Andrews concludes that patients who use antidepressants can be nearly twice as susceptible to future episodes of major depression after they go off the drugs.

Andrews, an evolutionary psychologist and assistant professor in the Department of Psychology, Neuroscience and Behavior, and his colleagues did a meta-analysis, reviewing dozens of previously published studies to compare outcomes of patients who used antidepressants to those who used placebos. Their findings suggest that those who do not take medication are at a 25 per cent risk of relapse compared to 42 per cent — or higher — for those who take and then go off antidepressants.

Andrews maintains antidepressants interfere with the brain’s natural self-regulation of serotonin and other neurotransmitters. The brain can overcorrect once medication is suspended, triggering a new and even stronger depression, he says.

He uses the metaphor of a spring to explain how this works. When a weight is placed on the spring, it compresses while at the same time building up an oppositional force. When the weight is removed, the spring releases and the coil stretches out further than its initial resting point.

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“Taking antidepressants is like pressing in the spring. The brain should be resisting that, producing an oppositional force. When the antidepressant is discontinued, the pressure so to speak that has been built up by the brain will cause depressive symptoms to resurge,” he explains.

An implication of the theory is that the relapse may be temporary, Andrews acknowledges. Again, using the spring analogy, the coil will eventually return to its natural resting place.

But some people can get stuck in a cycle where they need to keep taking antidepressants to prevent a return of the symptoms, he says.

And the possibility of a strong relapse can make it difficult to get off the drugs, he says.

“If you don’t understand the dynamic that is going on, you may just feel like, ‘Oh my God, I tried to go off these things and things got worse,’” he says.

The findings will no doubt fuel the ongoing debate about the effectiveness of antidepressants.

Asked if antidepressants should never be used, Andrews responded: “I am sort of on the antimedication spectrum. I personally would avoid it if at all possible. Having said that, I can imagine there are certain instances where it can be useful.”

Andrews’ take on the drugs is that they disturb the brain’s natural regulatory mechanisms. He believes that depression may actually be a natural and beneficial — though painful — state in which the brain is working to cope with stress. Just as the body uses fever to fight infection, the brain may use depression to fight unusual stress.

“This (study) poses some interesting questions for the people who prescribe these antidepressants and their patients: If I am depressed now and I go off these drugs am I going to have to deal with a worse depression later on? Is it better to wait it out now? Our data could suggest in many ways, yes.”

Some 6.6 per cent of Ontario adults use antidepressants, up from 3.6 per cent in 1999, according to the Centre for Addiction and Mental Health.

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